Urgent mental health care needed in Iraq

The Iraqi government has recognized that the growing and widespread mental health crisis in the country needs urgent attention, and has asked MSF to help it develop policies to deal with the situation, the charity’s country director says. In an interview with The Daily Star in Beirut, Fabio Forgione, the Iraq head of mission for Médecins Sans Frontières, says that while the issue of mental health has generally been stigmatized in the Middle East for years, the Iraqi authorities are keen to develop policies to address the needs “which are now considered as widespread and very high by everyone.”

MSF works across Iraq, except for areas controlled by ISIS, with over 600 staff. Among its patients, Forgione says that most people are in need of psychosocial support, even if they are being primarily treated for physical illnesses.

“The majority of the people who we are serving have gone through a situation of trauma, they have witnessed violence either directly or indirectly,” Forgione says.

“Therefore, having the possibility to be counseled, to be seen by specialized people, be they psychologists or counselors, is extremely important in this period of recovery for them.”

Already deeply scarred by the 2003 U.S.-led invasion and the subsequent 2006-2007 civil war, Iraq’s progress was again stalled in 2013, following the ISIS takeover of Fallujah, exacerbated last year when the extremist group suddenly seized around a third of the country.

There are now over 3.5 million internally displaced persons inside Iraq, according to the UNHCR, and the country also hosts around 250,000 Syrian refugees.

Forgione predicts more chaos to come, and urges greater international attention to the crisis.

“Further waves of displacement are very likely to happen considering that heavy battles for key areas such as Anbar and Mosul are expected to happen,” he says, “and therefore it is extremely important that the involvement and engagement of the international communities and international donors to sustain the humanitarian response in Iraq is continuous and coherent.”

Many of the IDP populations reside in areas close to the front line, and many have limited freedom of movement, so MSF’s work in Iraq mainly involves mobile health clinics, which can reach those in need of help.

“It is extremely important not to wait for IDP to come to your centers, but make sure that you can reach them,” Forgione says.

Most of the patients that MSF treats are seen for chronic illnesses, such as diabetes, hypertension and cardiovascular disease, Forgione says, problems they were unable to tend to during their forced displacement.

“So one of our main priorities is to allow this treatment to continue so it does not trigger further complications which could be very serious for the health of the individual,” he says.

Due to the lack of sufficient post-operative care within Iraq and the unstable security situation, MSF refers wounded Iraqis to its hospital in Jordan’s Amman, which provides reconstructive surgery, psychosocial support and physiotherapy.

The hospital was officially opened earlier this month, but the project first began in 2006. Last year, 150 Iraqi victims of violence were treated at the center.

The charity also provides logistical support, getting the victims and their next of kin to Amman, and putting them up in accommodation.

But in a country where car bombs go off nearly daily, how do you decide who gets treatment at this state of the art facility?

Of course, Forgione says, “this is one of the main discussions that we have. There is a certain capacity the hospital can have and of course in consideration of the magnitude of the regional conflict it’s basically impossible for the hospital to cover all the needs.”

A network of MSF medical liaison officers on the ground in Iraq refer the most needy cases, based partly on the severity of the injuries.

The Amman hospital offers a glimpse of what long-term, large-scale projects can achieve, and Forgione sees scope for more such facilities in the future, funding and staffing dependent.

“This is a very long-term project which is not easy to replicate because of course it takes a huge amount of resources, but it has been very successful,” he says.

Not in receipt of international government funds due to the organization’s founding principle of remaining independent, MSF relies mainly on private donations.

It is also relatively unique in terms of solely providing direct assistance – i.e. at the point of care, rather than, for example, simply handing medical kits to the government, which are more likely to disappear and not reach those in need.

The key concern Forgione sees for Iraq at the moment is that there is currently no end in sight to the conflict, so longer-term planning and projects are vital.

“This is a crisis which is expected to escalate, it is a crisis in which no solutions are seen.”

Also, he says, a more national response is needed.

“Secondly, to make sure there is a major and wider involvement as a whole, a national approach. All the regions where IDP are located, especially in central Iraq, should be addressed, in the wider presence of NGOs and international humanitarian actors, which is today lacking.”